Ohio Medicaid To Revamp Its Managed Care Program

The Ohio Department of Job and Family Services (ODJFS) is revamping its Medicaid Managed Care Program to stress pay for performance and will be reducing the number of service regions from eight to three, beginning January 1, 2013.

Managed care plans that respond to the department's request for application (RFA), released January 10, 2012, will be evaluated on the basis of past performance in coordinating care and high quality health outcomes. Ohio Medicaid will also use new managed care contracts based on model language developed by Catalyst for Payment Reform, a national, nonprofit organization dedicated to achieving better and higher-value health care.

The new contracts will increase expectations regarding the national performance standards managed care plans must meet to receive financial incentive payments. Plans will also be required to develop incentives for providers that are tied to improving quality and health outcomes for enrollees.

The new agreements reduce the number of service regions from eight to three and combine coverage for the Aged, Blind and Disabled (ABD) and Covered Families and Children (CFC) populations in each region. According to the department, the new design will increase individual choice and competition, because the New Medicaid Service Regions will allow Ohio to offer beneficiaries four plan choices, up from two or three currently, while preserving the relationships beneficiaries have with their doctors and other medical professionals.

Through the RFA process, ODJFS will select a limited number of applicants to enter into Medicaid managed care provider agreements with the state of Ohio. Eligible RFA applicants will be qualified managed care organizations that best demonstrate the ability to offer the required health care services, agree to meet Ohio’s program specifications, and ensure accountability and cost-effectiveness.

Ohio Medicaid issued a Feb. 27 deadline for letters of intent from prospective plans with applications due March 19. The agency will make tentative selections April 9, which will be followed by readiness reviews. Those plans that pass the review will be signed to final provider agreements Aug. 31. Medicaid recipients will begin to enroll in the new program Jan. 1, 2013.

The population to be served under the RFA includes approximately 1.6 million individuals enrolled in Ohio’s CFC program, 125,000 enrolled in the state’s ABD program, and 37,000 children with special needs. Ohio’s Medicaid program serves more than 2.1 million low-income Ohioans. Enrollment under the new contracts is expected to begin January 1, 2013. To view the RFA, go to http://jfs.ohio.gov/RFP/. Additional announcements and updates will be provided at http://mcp.ohio.gov.